New diagnosis - Feeling overwhelmed and hopeless (Blue has passed)

[Bluester]

Hello my name is Laura and I have a 12 year old female Beagle named Blue. Blue is my everything. She was diagnosed with Cushings on July 14th and was prescribed Vetoryl 10mg after the ACTH test. She weighs 21lbs.

Background:
About 3-4 years ago I noticed she started drinking more water and had to go outside more frequently and during the night. I immediately made her an appointment thinking it was a UTI. All tests were negative but it continued. I continued to bring it up but was told was probably due to her age. Around this time she also started getting skin lumps, her vet said were age warts.

In the last year she started showing additional symptoms. Increased hunger (eating everything including trash), shaking limbs, trouble jumping, insomnia, boney appearance and pot-belly.

Last month she started panting nonstop and started losing patches of hair. I took her to the animal hospital and was told it was most likely cancer and they ran some tests. After a week of crying thinking the worse, tests came back negative. A couple weeks later I took her for a bath and the next day her tail was completly bald from the bottom. I did some research and found oout about cushings disease. She had almost all the symptoms. I took her back to the vet and asked about Cushings. After the ACTH response test the next morning it was confirmed.

After Vetoryl:
She has been on the medication for almost 30 days now. The panting has stopped and she now sleeps through the night but everything else is the same or worse. She has several bald spots around her neck, back and chest now. Her skin looks very spotty. She continues to drink a lot of water then inflates like a balloon after for about an hour. The scary part is her eyes. I'm not sure what is wrong but sometimes after waking up it looks like she has lazy eye or had a seizure. Not sure how to explain but doesn't look at me the same.

I am not sure if we waited too long to get a diagnosis or I just need to give it more time. I have also purchased and started her on HMR Lignans and K9 Melatonin.

Any advice is appreciated. Sorry so long.

[Harley PoMMom]

Hi Laura,

I have manually approved your membership so now all your posts will be seen right away. Also, please just disregard the validation email that was sent to you from k9cushings.

Welcome to you and Blue! I am sorry for the reasons that brought you here but sure glad you found us and we will help in any way we can.

If you would get copies of all tests that were done on Blue and post those abnormal values along with their normal ranges it will enable us to provide you with better feedback, ok? ;) With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows. For the ACTH stimulation tests there will be two set of numbers: a pre value and a post value. Does your girl have any underlying illness that she is taking medication for? And if so, what is it and what is the medication? Is she taking any supplements, medications or herbs? Was an urinalysis done and if so could you post those findings too? Does she still have those skin lumps and was a skin scraping or biopsy performed to identify what they are? Did the vet perform any tests to differentiate between the adrenal or pituitary form of Cushing's?

Usually improvements in the drinking/urinating are seen within 2 weeks of starting treatment. The recommended starting dose for Vetoryl is 1mg per pound of a dog's weight which means that a 20 mg of Vetoryl would of been an appropriate dose for Blue's weight of 21 lbs, so it could be that the 10 mg may need to be increased. But I am glad to see that the vet did start her out at a lower dose because you just never know how a dog will react. And the go slow and start low is our motto here. ;) Now, a couple important questions I have; is Blue getting her Vetoryl with a meal so that it is properly absorbed? And is an ACTH stimulation test scheduled to see where her cortisol level is? Also, those monitoring ACTH stimulation tests have to be performed 4-6 hours post pill.

And just so ya know we love details so never feel like you are posting too much information. ;):)

Hugs, Lori

[DoxieMama]

Hi Laura,

Lori covered all my questions and ideas so I'll just say welcome to you and Blue! I look forward to learning more about your girl. :)

Shana

[judymaggie]

Hi, Laura and welcome to you and Blue! My beagle, Abbie, sends a big ar-o-o-o to Blue. :D

Is the issue with her eyes a constant thing or something that you notice occasionally? You mentioned the possibility of a seizure and, as you probably know, beagles are a breed that is prone to seizure activity. Have you discussed what you have seen with your vet? If this is an occasional thing, it is very difficult for a vet to determine a cause if he/she does not actually see it happening.

Hopefully, we can alleviate some of your feeling overwhelmed and hopeless. Abbie is my second beagle Cush pup and I found that reading and learning as much as I could about Cushing's helped immensely. Take some time to browse in our Resources forum. Here is the link:

http://www.k9cushings.com/forum/forumdisplay.php?f=10

[Bluester]

Thank you everyone! I am already feeling better knowing I have some support.

Lori, here are the lab results. She had a full blood, urine and fecal analysis done.

Lab Test Lab Result
Cortisol Sample 1 4.4
Cortisol Sample 2 53.9

For the urine it says WBC negative, color and appearance abnormal, RBC positive, specific gravity 1.006, protein 300.0, glucose 0.0, and pH 6.0.

I don't see anything regarding checking between adrenal or pituitary but I will ask this weekend when she has her next ACTH stimulation.

She has never been ill before this and continues to act like a happy/hungry dog. The only supplement she took before the diagnosis was Cosequin which I started giving her when she started shaking and having problems jumping and Clavamox twice this year when I took her in for the balding/masses on her skin.

Yes she had a biopsy back in March and it was negative. No neoplastic cells identified. No evidence of malignancy.

Should I continue the Lignans and Melatonin? If so do I give her all 3 meds together? I have been giving her the Vetoryl and Lignans in the late afternoon and the Melatonin before bed.

Judy, I have only noticed it a few times and no other indications. Thanks for the nice welcome!

[labblab]

Hello and welcome from me, too! I'm afraid I have only a moment to post, but I want to caution you about dosing Blue with her Vetoryl in the late afternoon. In order to obtain useful results, monitoring ACTH tests should be administered 4-6 hours after the Vetoryl is administered along with a full meal. In order to be metabolized properly, Vetoryl should always be given with a meal. So there are two issues here: is Blue getting her Vetoryl with food, and on your current dosing schedule, can the test be run 4-6 hours later?

From what you've written above, it's not clear to me whether or not this will be Blue's first or second monitoring test. But either way, I'm hoping you will be able to adjust her dosing appropriately for any future tests. As Lori had suggested, it may be that she needs a larger dose of Vetoryl to control her symptoms, and accurate testing will be an important tool in figuring that out.

Also, if you want to continue giving the lignans and melatonin, there is probably no problem with that, although I'm not sure how much they are benefiting her. Lowering her cortisol would seem to be the top priority right now, and the Vetoryl has far more of a powerful effect in that regard. Also, I'd probably not give the lignans directly alongside the Vetoryl unless you can verify that there's no risk of the lignans interacting in some way. You might contact Dechra, the manufacturer of Vetoryl, in order to see whether there is any interactive effect.

Marianne

[Bluester]

Hello and welcome from me, too! I'm afraid I have only a moment to post, but I want to caution you about dosing Blue with her Vetoryl in the late afternoon. In order to obtain useful results, monitoring ACTH tests should be administered 4-6 hours after the Vetoryl is administered along with a full meal. In order to be metabolized properly, Vetoryl should always be given with a meal. So there are two issues here: is Blue getting her Vetoryl with food, and on your current dosing schedule, can the test be run 4-6 hours later?

From what you've written above, it's not clear to me whether or not this will be Blue's first or second monitoring test. But either way, I'm hoping you will be able to adjust her dosing appropriately for any future tests. As Lori had suggested, it may be that she needs a larger dose of Vetoryl to control her symptoms, and accurate testing will be an important tool in figuring that out.

Also, if you want to continue giving the lignans and melatonin, there is probably no problem with that, although I'm not sure how much they are benefiting her. Lowering her cortisol would seem to be the top priority right now, and the Vetoryl has far more of a powerful effect in that regard. Also, I'd probably not give the lignans directly alongside the Vetoryl unless you can verify that there's no risk of the lignans interacting in some way. You might contact Dechra, the manufacturer of Vetoryl, in order to see whether there is any interactive effect.

Marianne

Thank you so much, I will start giving it to her in the morning now. She does take it with food.

She has only had the initial test the next one is in a few days.

[molly muffin]

Hi and welcome from me too. Lets see how things go on the medication and see if some of this can't be turned around.

When is the next test? You said a couple days. And what are the results of that and how is dear Blue doing now?

[Bluester]

Hello! Sorry, it has been a while since I shared anything.

Blue was diagnosed July 2016. Her levels were at 53.9 at the time. She had ALL the symptoms and had been misdiagnosed a couple times. Her vet started her at 10mg of Vetoryl. There were no noticeable changes to her levels but some of her symptoms did get better.

She was on 30mg for about 3 1/2 months but after her last test her levels were at 30 so we changed her to 30mg twice a day instead of once a day. She also lost weight but still eating like normal.

She is not reacting well to the higher dosage. Started losing hair within days and other skin issues. I started her on Melatonin again and that seemed to get better but she has a lot of stomach issues so vet changed her to 30mg in the morning and 10mg at night starting tomorrow.

I also feel like she is a bit sad. She is still always hungry and she still drinks a lot. She still shakes a lot (limbs).

[labblab]

Welcome back to you and Blue! I'm sorry I have only a moment to post right now, but I will come back later in order to add a more complete reply. However, in the meantime, I wanted you to know that I've merged your new post into your original thread about Blue. This way, it'll be easier to keep Blue's history as well as everyone's thoughts and suggestions all consolidated in one place. ;)

Once again, glad to have you back!
Marianne

[Bluester]

Great thank you Marianne!

[Carole Alexander]

I'm sorry to hear that Blue is not responding well to the higher dosage of Trilostane. I know how frustrating and complicated this dosing issue is. My dog, Skippy has been on the drug for nearly a month although I think he has had Cushings for at least six months, probably longer. He too has shown very limited improvement, still shaking, hungry, drinking and losing hair. Skippy too seems sad and depressed. But, I choose to believe that if we can get the Cushing's under control, Blue (and Skippy) will bounce back to whatever their new normal is. And, it will be better than today. Please know that I am thinking of Blue and you.

[labblab]

OK Laura, here I am back again. Like Carole, I'm very sorry that Blue isn't feeling better than she is right now. A couple of questions/thoughts do come to my mind. Can you tell us the date of the second monitoring ACTH test when her result was around 30? How long has it been since then that her dosage had been increased to 30 mg. twice daily?

Also, were other blood or urine tests run at the same time? I am wondering whether any additional problems have cropped up in her lab work, specifically markers related to her kidney or liver function, and also her thyroid level. The thing is, elevated thirst and urination can also be caused by problems other than Cushing's. Since Blue's cortisol level has remained high thus far, that may remain the sole cause. But it is also important to monitor blood chemistries, too, in order to watch for other abnormalities.

I am also wondering whether she has ever had an abdominal ultrasound performed? Given her ongoing issues, this may be a helpful diagnostic because it allows the vet to see whether an adrenal tumor may be present that might account for the difficulty in lowering her cortisol, and also to check the status of other internal organs (liver, kidneys, spleen, gallbladder, etc). Again, it may be the case that Cushing's is not Blue's only problem and an ultrasound can help identify other areas that need attention.

These are just some thoughts for me to throw out to you. Most of all, if you can get copies of any recent blood/urine tests in addition to the second monitoring ACTH, that would be a helpful place for us to start.

Marianne

[judymaggie]

Hi, Laura -- others have covered my thoughts so just want you to know that Abbie and I are rooting for Blue to feel better!

[Bluester]

Thank you for the responses, advise and encouragement. It really means a lot to have a group that understands.

Last ACTH and blood work was done on 12/14/2016. Urine and blood were all normal/negative. Last time her liver enzymes were a little high so she was on Denamarin for a month.

I don't believe she has had nn abdominal ultrasound preformed. I will call her vet about it.

She has had a lot of stomach issues (gas, diarrhea) since she started on the medication. She still has a lot of tremors/shaking and still has a pot belly. She is still drinking a lot of water and she also gets in the pool and drinks pool water too. I'm sure this is not helping and I have tried to stop her but not sure if she just likes the cold water on her paws because she is in pain. She never liked the water before.

Here is her Vetoryl dosage and results. Just changed her meds again a few days ago.

July - Aug 10mg - Panting stopped and less urination.
Aug - Dec 30mg - Little loose stool, hair started growing back.
Dec (for 2 weeks) 30mg twice a day - excessive gas and diarrhea, some blood in stool, air falling out again.
January - 30mg morning and 10mg at night. Too early to tell.

[Bluester]

It has been almost a week since Blue went on 30mg in the morning and 10mg in the evening instead of 30mg twice a day and I already see her stomach issues are better.

Hope this new dosage is what she needed for now. She is now 20lbs and her boney appearance/muscle loss is showing more and more. It's hard to see her skinny since she has always been such a big eater. Her potbelly makes her look fat to other people but she has never been this thin.

[Harley PoMMom]

Glad to hear that she is doing better on her dosage regimen. How is her appetite?

Hugs, Lori

[molly muffin]

Oh dear poor girl. Hopefully the thinness will correct itself, once the stomach issues are over with.

[Bluester]

Glad to hear that she is doing better on her dosage regimen. How is her appetite?

Hugs, Lori

Her nickname is McFatty. She is always hungry. Sad but the day she is not hungry will be one of the hardest, I will definitely know something is wrong.

[BrittanyandJJ]

Hi There!
I just wanted to post because I my canine is everything to me as well. I am sorry your little one is not responding well to the medication and is so thin and shakey. I have not had the best experiences with my local vets who claims they can help but have never actually dealt with Cushings. Have you sought out a specialist? I am working with someone who is a few hours away from me over the phone. I get the blood work done at my local vet and send him the results. before deciding he was competent to handle my situation I asked many questions and made sure he has in fact treated Cushings before. The specialist you would nee should be an Internal Medicine Specialist. Best of luck. Much Love.

[BrittanyandJJ]

Also, Does your baby still have open wounds? Are there hard deposits on skin? Could it be Calcinosis?

[BrittanyandJJ]

One more thing. Have you spoken the vet about the shaking? Was Blue shaking before starting treatment?

[Bluester]

One more thing. Have you spoken the vet about the shaking? Was Blue shaking before starting treatment?

Hello yes she was shaking before starting on the medication. She shakes the most while drinking water. I bring it up every month.

As far as her open wounds I just recently heard about Calcinosis Cutis, in this forum. Her newer bald spots are smooth, the area just looks as if she was shaved but a bit red/raw looking. I spray an antibiotic on them when I see them (always same area) and that seems to help dry them up. As far as her skin lesions she started getting them on her limbs several years ago, was told they were just age warts. In the last year she started getting them all over her body.

[Squirt's Mom]

Try elevating her water bowl and see if that helps with the shaking while she drinks.

[Bluester]

Try elevating her water bowl and see if that helps with the shaking while she drinks.

Thank you I will!

[BrittanyandJJ]

Hi There!
JJ had a dermatology appointment yesterday and I was informed that the bloody wounds he had last month as well as the hair coming out in big bloody patches could be in part to mites. Mites are naturally on the body but when the immune system is compromised by things such as CC or any other health issue the mites can get out of control. He did a simple hair plucking test and confirmed demodex mites. To fix this JJ has been prescribed an oral pill once a month that also fights fleas and ticks. Its called Simparica. If there are bloody spots on Blue's skin maybe have a hair plucking test run? Also, to calm the inflammation around the CC deposits I was given topical drops for once a day application called Douxo. I already see improvement with the redness. Hope this helps?

http://www.douxo.us/documents/DOUXO-SEBORRHOEA-SPOT-ON.pdf

[Bluester]

Thank you Brittany. I added some pictures to an album named skin problems that shows what she has. When you get a chance can you please take a look and let me know if that is what your baby has? Thanks again really appreciate it.

[molly muffin]

How is she doing now on the 30/10 dose? Eating any better? or seeming to be putting on any weight I should say?

My dog never developed the skin issues so i can't really comment on that unfortunately. But I'm not sure that it looks like other pictures of cc I have seen either.

[Bluester]

How is she doing now on the 30/10 dose? Eating any better? or seeming to be putting on any weight I should say?

She seems to be doing well. Her appetite is good and she looks happy. Is sleeping a bit longer than she was. Only issues are the skin ones with hair loss and still always thirsty and her potbelly.

[molly muffin]

Okay so that is good. Is she putting on any weight?

[Bluester]

No she is not putting on any weight yet. She is for sure looking and acting better though.

[judymaggie]

Hi -- so glad that you are seeing positive changes in Blue. You might try adding some pasta to Blue's food to try and add some pounds. I found some cavetella which is really small and doesn't have to be cut up. Maybe Blue will like it better than Abbie did ...

[Bluester]

Hi -- so glad that you are seeing positive changes in Blue. You might try adding some pasta to Blue's food to try and add some pounds. I found some cavetella which is really small and doesn't have to be cut up. Maybe Blue will like it better than Abbie did ...

Thank you Judy she will love that.

[Carole Alexander]

Hi again, this problem of dosing combined with a lack of knowledge of Cushings by many vets is a much larger issue than I ever imagined, especially in light of the prevalence of Cushing's. The have upped Skippy's Trilostane a modest amount starting tomorrow to 15/10. (He was on 10/10 since early December) But Skippy is almost the same weight as Bluester (29lbs). These vets are very conservative and I appreciate that they don't want to overdose him but his Cortisol is still way too high. This is a long rocky road but it sounds like you and Blue are finally nearly there. Good for you for your caring, patience and endurance.

[Carole Alexander]

Forgot to ask: are you still giving Blue the Melatonin and Lignans? Do they seem to be helping?

[molly muffin]

Is blue loving the pasta? Great that she is looking and acting better. Hopefully the weight will come along with her feeling better.

[Bluester]

Forgot to ask: are you still giving Blue the Melatonin and Lignans? Do they seem to be helping?

She has been doing so mucb better since we lowered the dosage again. Biggest issue other than stomach problems with the twice a day was with her skin and hair. As soon as her dosage was lowered her hair gets softer.

Yes I still give her the melatonin every night and she sleeps so much better. I have not given her the Lignans since we started changing her dosage. Just didn't want to be giving her 4 different pills.

[Bluester]

Is blue loving the pasta? Great that she is looking and acting better. Hopefully the weight will come along with her feeling better.

Yes she is! She seems to be putting on a little weight finally.

Thank you for checking in :)

[WeLoveAthena]

Hi...Going through a lot with our dog Athena and her Cushing's so we understand.
Her shaking some in the legs was a bit of arthritis and they gave her some tramadol for that. It helps her and she doesn't appear sore or anything and the shaking is gone
Right now we are just working on her Cushing's issue but the shakiness was her joints being sore from the extra weight due to Cushing's and we are happy that at least the tramadol is helping her through this. It also helps her sleep better too. Just a thought.

[Bluester]

Hi...Going through a lot with our dog Athena and her Cushing's so we understand.
Her shaking some in the legs was a bit of arthritis and they gave her some tramadol for that. It helps her and she doesn't appear sore or anything and the shaking is gone
Right now we are just working on her Cushing's issue but the shakiness was her joints being sore from the extra weight due to Cushing's and we are happy that at least the tramadol is helping her through this. It also helps her sleep better too. Just a thought.

Wishing Athena gets better soon. Sometimes all we can do is show them how much we love them. I will ask about the Tramadol, thank you!

Blue just started losing her hearing. It just started not sure if age or maybe the medication. My other beagle went completely deaf not too long ago and depends on Blue a lot. This weekend was hard I hate to startle them both when I approach them.

[molly muffin]

Awww, thats tough having two with hearing loss. Do they respond to vibration? maybe there is a way to get their attention without startling them. Not sure what exactly but just throwing that out there. Would a thump do it? do a wall or floor maybe?

[Joan2517]

Try stomping on the floor. That used to work with Lena. Or sometimes I would put the flashlight on on my cell phone and shine it around her so she would look up. She could still hear very loud noises like if I clapped my hands or whistled. If she was in a really sound sleep, I would pet her gently, so that she wouldn't be so startled. It took time, but we got used to it.

[Bluester]

Hello just providing a quick update on Blue.

After I feel she was being overdosed with 2 35mg pills a day I thought she may have CC. Her hair got really ugly like it was before being diagnosed and she had calcium looking hard deposits on her upper back. She was also having a lot of stomach issues and was very lethargic. I put her back to 1 pill a day over a month ago and she is doing so much better. All her calcified hair fell off too.

No changes in eating but I have finally started noticing a decrease in her drinking.

We will be celebrating her 13th birthday in a few weeks. :)

Anyway just wanted to share some good news.

Laura

[Joan2517]

Awwww, so glad she seems to be feeling better. That is good news, which we love to hear.

[judymaggie]

Woo-hoo (or as Abbie says "A-roo-roo")! So glad that Blue is doing better and I bet she is looking forward to some yummy birthday treats! :D

[molly muffin]

Good news that you are seeing positive signs of symptom decrease.

So now she is on 35mg once a day right?

Awww birthday treats. Yum! LOL

[Bluester]

Good news that you are seeing positive signs of symptom decrease.

So now she is on 35mg once a day right?

Awww birthday treats. Yum! LOL

Yes that is correct 35 once a day.

[Bluester]

Yesterday was Blue's 13th birthday. A year ago when we were unsure what was wrong with her we didnt think she would make it to her next birthday. So grateful for each day.

We had some family over the weekend and they couldn't believe how much she has aged in the last year. I hadn't noticed she was so thin and frail until my family was cimparing her to our 14yr old beagle.

She still seems happy and has no problem eating. Has a lot of gas, same pot belly and shaky limbs.

I bought her some Milk Thistle since her liver enzymes were slightly higher. Has anyone had an issue with giving these supplements with Vetoryl (not together)? She also takes melatonin at night.

Laura
I

[Budsters Mom]

Happy 13th Birthday Blue!:p

[DoxieMama]

Happy birthday!

[Joan2517]

Happy Birthday, Blue~

[Harley PoMMom]

Happy Birthday, Blue!!!

Regarding the Vetoryl, melatonin, and milk thistle, I know of no bad interactions with using them together, many of our members (including me) have used them in conjunction with Vetoryl and had no adverse effects.

Hugs, Lori

[Squirt's Mom]

Happy 13th Birthday, Blue!!

[judymaggie]

Happy 13th birthday, Blue!

Abbie sends you a big A-R-O-O!

[molly muffin]

A Happy Belated Birthday to Blue.

I think we often don't see the changes as much ourselves since we are with them every day. Then someone comes over and it does hit you in the stomach when they say the changes they have noticed. Especially if they aren't rebounding, doing so much better type of changes. What we hope is that the next time they see Blue, it will to notice how much better she is doing. (i live in an optimistic world.) :)

[Bluester]

Happy Monday!

Blue had a rough weekend was very lethargic and shaking more than normal so I had to take her in for some tests. Her liver is enlarged, she has some fluids in her lungs and has a heart murmur.

She was given some additional meds I was told they would not interact badly with her Vetoryl but want to make sure incase any of your babies have taken the same medications.

Vetoryl 30mg
Pimobendan 5mg (1/2 pill)
Tramadol 50mg
Gabapentin 100mg
Milk Thistle
Melatonin 3mg

Thanks!
Laura

[molly muffin]

Why are they giving her both tramadol and gabapentin? did they say?

None of these along should interact with the vetroyl.

tramadol and gabapentin are for pain, Pimobendan for heart and milk thistle and melatonin for elevated sex hormones associated with cushings.

[Bluester]

Tramadol for overall pain and Gabapentin for nerve pain and tremors.

[Bluester]

Hello a little update on Blue. It has been 10 months since she was first diagnosed and started on the trilostane. It has been up and down for her since and we have changed her dosage a few times.

She is still eating normal and is still drinking excessively. Has a lot of really bad gas and sometimes loose stools.

She is now having a hard time walking. One of her back legs is almost to the point where she is having to drag it while the opposite front one is shaking if she is standing still. She doesn't complain about it but will have tremors so I believe she is in pain. The gabapentin seems to help some with the walking. She is also taking tramadol. I'm so afraid of the two together and her just being drugged all the time or feeling worse. Vet said to give her each every 12 hours.

[Harley PoMMom]

So sorry that Blue is having trouble with walking. :( I take gabapentin for the nerve pain in my leg and I also have vicodin. When I know that I will be on my feet for a period of time I take both the gabapentin and vicodin together and it helps immensely, I can actually walk almost normal and without a limp. So hopefully the combination of the tramadol with the gabapentin helps Blue in the same way. Also, I've never had any adverse effects from taking them together.

When was Blue's last ACTH stim test and what were those results?

Hugs, Lori

[Squirt's Mom]

When was the last time her cortisol was checked? If the cortisol is not well controlled she could be experiencing some muscle wasting in the back legs - common with elevated cortisol. Are you seeing any other changes in her behavior, etc?

[Bluester]

Her last test was less than 2 weeks ago. I didnt get a copy of the results yet but was told she was >20. The previous test she was at 30 and we increased her dosage but she didnt do well.

She looks tired a lot now but maybe due to all the meds. Her potbelly is bigger, liver enlarged and I can see her muscle wasting on her back (looks super thin even thougg she looks fat cause of belly).

[Squirt's Mom]

hummm.....if that is >20 ug/dl then her cortisol is not controlled at all and is continuing to run rampant in her body. If you can please get a copy of the results and share with us. This may be what is wrong with her legs - cortisol is weakening the muscles and connective tissues. So please get the full info for us and we can go from there.

Is she getting the med with food every time? And the ACTH is done at the correct time after the dose and meal? She's not being fasted for the ACTH is she? These answers are more than likely in the earlier posts but I'm lazy today so I ask instead of look. :D

[Bluester]

hummm.....if that is >20 ug/dl then her cortisol is not controlled at all and is continuing to run rampant in her body. If you can please get a copy of the results and share with us. This may be what is wrong with her legs - cortisol is weakening the muscles and connective tissues. So please get the full info for us and we can go from there.

Is she getting the med with food every time? And the ACTH is done at the correct time after the dose and meal? She's not being fasted for the ACTH is she? These answers are more than likely in the earlier posts but I'm lazy today so I ask instead of look. :D

Yes she was fasting when they took the test 2 months ago because she was havung her teeth cleaned. Then this last time she got her pill in a pill pocket but no other food since she was having some heart tests.

Just talked to her vet she doesnt want to do another test too soon but said to up it from 30mg to 40mg for now then test again in a month and if not better up to 60mg. Also said maybe we can fo 60mg just once every few days since the last time she didnt do well. She is down to 20lbs right now. Does this sound right giving different dosages?

[Joan2517]

I could be wrong, but I don't think the test results are accurate if she is not getting a meal with her Vetoryl. And with all the other testing at the same time, I would expect her stress level to be very high.

[Harley PoMMom]

Joan is right, Trilostane has to be given with a meal (not a snack or a treat) to be absorbed properly, if this isn't done than those ACTH stimulation test results are skewed and the adjustment in the Trilostane dosage will be based on inaccurate information.

If this were me, I wouldn't change her Trilostane dosage until an ACTH stimulation test is performed according to proper protocol, which the vet should do for free since the other ACTH tests were not done to the correct procedure that is published.

Loro

[Bluester]

It has been a year since Blue was diagnosed and stared her medication. Until the last couple of weeks she has never had any problem eating anything including her medication. I'm sure all Beagle parents know what I'm talking about.

She now refuses to eat anything now without properly smelling and inspecting it. Since we were using pill pockets for a long time she won't even eat them if they are empty. She is taking a 30mg and a 10mg pill now and it is so hard. We have even caught her pretending to take the pill and then spitting it later in a different location. She has also started vomiting a lot lately.

Dogs are smart so I am afraid she doesn't want her meds because they are making her feel worse. I never thought the day would come when she refused to eat something. It is so hard and sad to see her this way. Other than that and the shaking/tremors she seems fine considering she is 13 and has cushings.

[labblab]

In looking back, I think your vet was intending to perform a monitoring ACTH test around June 20th? Was that test done, and if so, can you tell us the results? If it wasn't, I really think you need to have one done as soon as you can schedule it. Loss of appetite and vomiting can be signs that Blue's cortisol has dropped too low, and continuing to give trilostane to a dog with low cortisol is dangerous. Please watch her closely and let us know if her vomiting continues or if she develops additional symptoms of low cortisol such as diarrhea or lethargy.

Marianne

[Bluester]

Thank you Marianne. Yes she did have the test and actually has another one scheduled for this Tuesday the 4th. I don't have a copy of the last results with me but she was still high and they changed her back from 30mg to 40mg at the time and were to check again after 2 weeks. She has gone back and forth from 30 to 40 for past 6 months.

Here is the odd part they asked me to bring her in on an empty stomach for 1st part then they would give her her med and food for the 2nd part. I had to bring in her pill and some food for them to administer. This was only after I complained about all the tests being do e incorrectly (pill but no food).

[Budsters Mom]

No meal. No test. It's as simple as that. Without a meal, you are throwing your $$$$$ down the drain!! I don't undestand your vet's thinking???


Trilostane has to be given with a meal (not a snack or a treat) to be absorbed properly, if this isn't done than those ACTH stimulation test results are skewed and the adjustment in the Trilostane dosage will be based on inaccurate information.

[Squirt's Mom]

They have no idea what her cortisol is since they are doing them incorrectly and will not listen to you. :(:(

[labblab]

Here is the odd part they asked me to bring her in on an empty stomach for 1st part then they would give her her med and food for the 2nd part. I had to bring in her pill and some food for them to administer. This was only after I complained about all the tests being do e incorrectly (pill but no food).
The only thing I can think is that they are wanting to use a fasted blood sample to perform other lab analysis. So maybe they think this is the solution: to draw blood for the resting cortisol level along with blood for the other testing, then give the trilostane/food/stimulating agent, and then draw the second post-ACTH sample afterwards.

The huge problem with this (if this is what they're doing) is that the timeframe for the post-ACTH test is totally messed up. Typically there is only one hour between the first blood draw and the second. So that is not enough time for the trilostane to have been administered, metatabolozed, and had maximal effect on Blue's cortisol level. Dechra (maker of Vetoryl) says the test should be run 4-6 hours after eating and taking the drug. Some researchers and clinicians prefer testing a bit earlier, like 2-3 hours after ingestion. But I've never heard of anyone testing only one hour or less after taking the trilostane. By doing that, once again you risk getting a cortisol level that is much higher than it would be if you were testing within the proper timeframe.

I, too, am so frustrated with your vet's inability to perform this most important monitoring test properly!

Marianne

[molly muffin]

Any ACTH done with the way described as your vet is doing them, isn't worth anything and won't tell you accurately how Blue is reacting to the medication.

I'd request (you are paying after all) that a Proper ACTH test following protocol be done. It doesn't look like you can have an accurate test based on the last few your vet have done, which doesn't follow any type of protocol as set out by manufacturer. So would it be possible to say, do this one the way I want, following dosage protocol. And see what that result i?

[Bluester]

Any ACTH done with the way described as your vet is doing them, isn't worth anything and won't tell you accurately how Blue is reacting to the medication.

I'd request (you are paying after all) that a Proper ACTH test following protocol be done. It doesn't look like you can have an accurate test based on the last few your vet have done, which doesn't follow any type of protocol as set out by manufacturer. So would it be possible to say, do this one the way I want, following dosage protocol. And see what that result i?

Thank you I took her in this morning after giving her, her 2 pills and her meal. I expressed my concerns about the previous tests but the doctor wasn't in yet so the poor nurse had to listen to me. They had instructions for a bunch of others tests just like they do each time I take her but I asked that they only concentrate on the ACTH test for once. She is on a wellness plan so most of the other tests are included with her plan. Sad part is she didn't want to be there. This is the 1st time in 13 yrs she is afraid of being at the vets office. I felt horrible leaving her and scared it coyld be the last time and she was trying to tell me something.

When I picked her up I noticed I was charged for more than the normal fee, so frustrating but I just wanted to bring her home. I got copies off all her previous tests finally (was only told over the phone last 2-3 times). Just waiting to get her new results now so I can post.

She seems more her old self last few days so that makes me feel better.

Thank you everyone for your advice and support.

Laura

[molly muffin]

Good for you. Sometimes you have to narrow things down one at a time. I think that is one of those times. This is a very good start.

[Bluester]

Finally received a call from Blue's doctor regarding her test results from Tuesday and her post number was 15.9. Not sure if this is a great number but better than then 20s and 30s she was getting when taking the test without a meal.

He said to leave her on current dosage and to take her in next month for her other tests. I will go pick up copies of results tomorrow.

Laura

[Bluester]

Not even 3 weeks ago I was sure Blue would not make it through the rest of the summer. She wasn't herself at all and it was obvious how tired she was. She was refusing to take her medicine and for the first time in her life was picky about what she ate and how much she ate.

So much has changed in the past 2 weeks and my entire family has noticed it. I can't really say we are doing anything different so not sure why the sudden change. We first noticed that all of a sudden she could jump on the couch again. Then her dog tear stains went away. Her pot belly is also all of a sudden gone and her back isn't arched the same way.

I'm guessing her levels are finally where or close to where they should be and after a year we are finally seeing the results. Whatever it is I am so happy to see my old lady back. She looks so happy and it makes us all happy.

Laura

[Harley PoMMom]

I am so glad to read that Blue is doing much better!! A post of 15.9 ug/dl is still kinda high but if she is feeling well and her symptoms are controlled than that post number may be where she needs to be. Has another ACTH test been scheduled?

Lori

[Bluester]

I am so glad to read that Blue is doing much better!! A post of 15.9 ug/dl is still kinda high but if she is feeling well and her symptoms are controlled than that post number may be where she needs to be. Has another ACTH test been scheduled?

Lori

Not until September unless she gets worse. Should we have it done sooner?

[molly muffin]

optimally you want the post number at under 9.0ug with no symptoms. I''m not saying you should do another test sooner, just that if she remains around 15 post and this is testing after giving her the pills with her meal, then you might want to do a slight increase to get the post result down a bit further.

15 is definitely better than 20 - 30 and probably is more reflective of giving her the pills with her meal and testing than without. It doesn't absorb properly without a meal, so that is why the higher score. See where she is in September.

Glad to hear she is feeling so much better

[Bluester]

Sorry it has been a while since I posted.

Blue has been up and down the last few months. Showing less symptoms of cushings but has loss weight, is sleeping more and is losing her hearing and sight.

She had her quarterly blood test a couple days ago and she has high blood pressure, elevated blood platelets, is dehydrated and her liver and kidney enzymes are a lot higher.

Today I started her on enalapril and also simplicef for the next 10 days incase there is an infection.

Hoping she starts feeling better soon.

[Harley PoMMom]

When was Blue's last ACTH stimulation test done?

[Bluester]

When was Blue's last ACTH stimulation test done?

In Sept her post was at 12. Her Dr didn't want to increase her dosage due to stomach issues.

[Harley PoMMom]

Was her Vetoryl given with a meal and then the ACTH stimulation test done 4-6 hours after that?

[Bluester]

Hello everyone! An update on Blue who should be turning 14 next month.

About a week ago Blue's abdomen started to distend quite a lot I took her to her vet and was told she was accumulating a lot of fluid and had ascites. I asked if we could drain the fluid and what to do next and was told it was too late to do anything that either her heart or liver were failing and that draining would either put her in more stress or would immediately return. I was then told it was time to make a decision because she probably only had a few days left. Was also told to discontinue all medication since there was no need for it.

We spent the rest of the day crying and family coming over to say their goodbyes. Blue loved the attention and endless snacks.

After a couple days I called her vet and because 2 years ago when she was diagnosed with cushings she told me to make a list of 5 things that represent her or she loves to do and when she can no longer do 3 of them then it was time. Well she is still doing 4 of these things so I am not ready to give up on her. I know she is old and has some issues but I just don't believe she is ready to give up. She is still eating and drinking normal, wagging her tail, following me around anywhere I go and not having any accidents. She still has a lot of gas and week in the limbs but that has been going on for a long time.

Has anyone experience ascites and if so did you get your pup treatment? I don't know if I should seek another opinion, get an ultrasound, put her on a diuretic treatment or if I am just in denial and this will just stress her out.

Laura

[molly muffin]

Oh Laura what a tough position to be in. Poor little Blue.
I don't have any experience with ascites, but it seems that the underlying cause is the most important factor as to how to proceed. Is it liver failure or heart failure. How is her breathing? If heart failure, then I'd think that the breathing would be effected. Any vomiting, etc? Cough? Pale gums, trouble breathing?
I think the main thing is that you don't want Blue to ever be in any distress. So if it ever comes to a point where it looks like she might be, then I'd make the call.
You could go to a specialist and maybe they could determine for sure the cause and if it is liver or heart failure, then there isn't much I think you could do. If it is some sort of bacterial thing, then they would prescribe antibiotics. I have just done some quick lookup reading for information, but like I said, have no personal experience.
Big hugs. It's a horrid position to be in and am sending all my best to you both.

[Bluester]

Thank you for the kind words and advice Sharlene, means a lot.

She does have pale gums and high blood pressure but no trouble breathing, cough or vomiting. Does have diarrhea so I did take her off the vetoryl as suggested. She is still on the enalapril for her high blood pressure which was diagnosed in December and she has a heart murmur which was diagnosed in September I believe.

[Harley PoMMom]

A diuretic may help. Sending huge loving hugs to you both.

[Joan2517]

I'm so sorry,, Laura. I think if you don't feel it's time, then just enjoy her until it is. You know her best and will know when the time comes. Hugs to you and Blue.

[DoxieMama]

My heart goes out to you. Please give Blue a scratch behind the ear and a belly rub from me (if she enjoys them).

My boy Visuddha had ascites, though we didn't realize it until too late. He declined over a week or two, though it seemed like overnight. He was a voracious eater (even before Cushing's) but one day did not want to eat or drink much of anything. His breathing was very labored and as much as I wanted to deny it, I had to take him in. The vet said it was congestive heart failure.

I hesitate to share this, but hope it helps you somehow.

So many hugs.
Shana

[Squirt's Mom]

Not having any experience with ascites I can't offer any suggestions. But I can and do offer hugs, ear scritches, and prayers. Enjoy your sweet boy as much as possible!

Hugs,
Leslie

[Bluester]

A diuretic may help. Sending huge loving hugs to you both.

Thank you!

[Bluester]

I'm so sorry,, Laura. I think if you don't feel it's time, then just enjoy her until it is. You know her best and will know when the time comes. Hugs to you and Blue.

Thank you Joan!

[Bluester]

My heart goes out to you. Please give Blue a scratch behind the ear and a belly rub from me (if she enjoys them).

My boy Visuddha had ascites, though we didn't realize it until too late. He declined over a week or two, though it seemed like overnight. He was a voracious eater (even before Cushing's) but one day did not want to eat or drink much of anything. His breathing was very labored and as much as I wanted to deny it, I had to take him in. The vet said it was congestive heart failure.

I hesitate to share this, but hope it helps you somehow.

So many hugs.
Shana

Thank you for sharing Shana means a lot.

Laura

[Bluester]

Not having any experience with ascites I can't offer any suggestions. But I can and do offer hugs, ear scritches, and prayers. Enjoy your sweet boy as much as possible!

Hugs,
Leslie

Thank you Leslie!

[Bluester]

My Blue passed away yesterday I wasn't ready to make that decision so her heart made it for me when it stopped. She was doing good up to the end. Had just had her last meal of chicken and rice and was walking around our yard. She was almost 14. Unfortunately she leaves behind her older sister who is deaf and depended on her completely.

[Joan2517]

Oh, Laura...I am so, so sorry. My heart breaks for you.

[molly muffin]

Oh Laura :( My heart just breaks for you and your family, including blues sister. I am so very sorry

[M&Inu]

I am so sad to hear this and offer you my condolences. I know there are no good words for something like this, but I want you to know I feel deeply for you and Blues sister. I wish you strength in the knowledge that you gave Blue such a good life. I am so sorry.

[Squirt's Mom]

Dear Laura,

When I first read your post I couldn't respond. A part of me just said, "Oh gods no, I'm not facing that loss right now." :( You and Blue fought so hard thru so many challenges but this last fight was one that could not be won. My heart just shattered knowing what you were and will be feeling. :( I am just so sorry.

You are a great mom and did everything within your power to make sure Blue's every day was the best you could give him. Please, do not let doubt, what-ifs, guilt take hold. They are stages of grief many of us experience but do not let them linger - you do not deserve the burden of carrying such thoughts for long. Blue enjoyed a wonderful life and many years thanks to your tender care. That is what he remembers....

Blue left this life on the wings of your love and I believe with all my heart that Blue remains with you in Spirit, that he is watching over you with the same love and devotion you gave to him. And I believe that one day you will hold your precious boy once again, that we will all be reunited with those we love, including our furbabies.

My deepest sympathies,
Leslie



Dogs Never Die

Some of you, particularly those who think they have recently lost a dog to “death”, don’t really understand this. I’ve had no desire to explain, but won’t be around forever and must.

Dogs never die. They don’t know how to. They get tired, and very old, and their bones hurt. Of course they don’t die. If they did they would not want to always go for a walk, even long after their old bones say:” No, no, not a good idea. Let’s not go for a walk.” Nope, dogs always want to go for a walk. They might get one step before their aging tendons collapse them into a heap on the floor, but that’s what dogs are. They walk.

It’s not that they dislike your company. On the contrary, a walk with you is all there is. Their boss, and the cacaphonic symphony of odor that the world is. Cat poop, another dog’s mark, a rotting chicken bone ( exultation), and you. That’s what makes their world perfect, and in a perfect world death has no place.

However, dogs get very very sleepy. That’s the thing, you see. They don’t teach you that at the fancy university where they explain about quarks, gluons, and Keynesian economics. They know so much they forget that dogs never die. It’s a shame, really. Dogs have so much to offer and people just talk a lot.

When you think your dog has died, it has just fallen asleep in your heart. And by the way, it is wagging it’s tail madly, you see, and that’s why your chest hurts so much and you cry all the time. Who would not cry with a happy dog wagging its tail in their chest. Ouch! Wap wap wap wap wap, that hurts. But they only wag when they wake up. That’s when they say: “Thanks Boss! Thanks for a warm place to sleep and always next to your heart, the best place.”

When they first fall asleep, they wake up all the time, and that’s why, of course, you cry all the time. Wap, wap, wap. After a while they sleep more. (remember, a dog while is not a human while. You take your dog for walk, it’s a day full of adventure in an hour. Then you come home and it’s a week, well one of your days, but a week, really, before the dog gets another walk. No WONDER they love walks.)

Anyway, like I was saying, they fall asleep in your heart, and when they wake up, they wag their tail. After a few dog years, they sleep for longer naps, and you would too. They were a GOOD DOG all their life, and you both know it. It gets tiring being a good dog all the time, particularly when you get old and your bones hurt and you fall on your face and don’t want to go outside to pee when it is raining but do anyway, because you are a good dog. So understand, after they have been sleeping in your heart, they will sleep longer and longer.

But don’t get fooled. They are not “dead.” There’s no such thing, really. They are sleeping in your heart, and they will wake up, usually when you’re not expecting it. It’s just who they are.

I feel sorry for people who don’t have dogs sleeping in their heart. You’ve missed so much. Excuse me, I have to go cry now.

[Bluester]

Thank you so much for the responses and beautiful words.

We held a memorial/viewing for Blue yesterday at the pet cementary.

[molly muffin]

Those are terribly hard to get through. It's even harder after they are gone and the emptiness sounds so loud.

[Harley PoMMom]

Oh Laura,

I am so sorry for the loss of your beloved girl, Blue, and my heart goes out to you and your family. You all are in my thoughts and prayers, sending huge and loving hugs.